A look at high intensity focused ultrasound removal of prostate gland: effects and complications

This study investigated the short-term functional measures and complications for high-intensity focused ultrasound (HIFU) treatment in half of the prostate gland (hemi-gland) for patients with prostate cancer (PCa).

The study showed that hemi-gland HIFU is a low-risk surgery and provides maintenance of sexual and urinary functions.

PCa can be present on one side of the prostate gland (hemi-gland PCa). The severity is determined by the measurement of several indicators. It can be assessed if the PCa is limited to the area of the prostate itself (localized) or has spread to other organs (metastasized). The level of prostate-specific antigen (PSA) can be measured. This is a PCa blood marker. A measurement of the Gleason grade can show if the cancer cells are similar to healthy cells (low grade) or have a different appearance (high grade). 

High PSA-levels and a high Gleason grade can indicate a more severe and progressed form of PCa. If this is the case, the PCa is titled as clinically significant (CS) PCa. In these severe cases, surgery might be necessary. If the PSA-levels rise above the lowest measure despite the surgery for more than 2ng/ml, the procedure is considered unsuccessful or biochemical failure (BCF).

HIFU is a radiation-free treatment to remove PCa tissue. It uses high-frequency ultrasound waves to heat and destroy cancer cells. It is performed through a probe inserted into the rectum. It is claimed to be more precise and have fewer complications than the traditional extensive PCa removal surgery. However, there are not yet many studies about its effects and risks in hemi-gland CS-PCa.

In this study, 101 men with localized, hemi-gland PCa participated. Patients had an average PSA level of 5.8 ng/ml when the study began. Hemi-gland HIFU was performed on all of the patients. The urinary and sexual function was assessed by questionnaires before and after HIFU. CSPCa and BF were observed. Patients were followed up for an average of 18 months.

Three months after HIFU, 76% of the patients reached their lowest possible PSA-level. After 18 months on average, 11% experienced BCF. At 6 months or more after HIFU, CSPCa was diagnosed in 20 patients. 7 men had repeat local HIFU, 8 men needed prostate surgery and 8 men underwent observance.

99% of participants maintained their urinary function. Sexual and urinary function-scores improved after HIFU. 13% showed minor complications. No major complications or deaths were measured.

The study concluded that hemi-gland HIFU is a safe and effective procedure. with good sexual and urinary outcomes in patients with localized PCa.

It should be noted that the study had a relatively small sample group. Any additional drugs the patients might have received as treatment were not available.